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<DIV dir=ltr align=left><SPAN class=797575117-04122008><FONT face=Arial
color=#0000ff>I would like to broaden the definition to include the concept of
the ability to act on the medical decisions made. It is not enough to understand
the information and make an appropriate decision; patients,
professionals and institutions need to be able to know how to actually
carry out that decision successfully. Part of the concept of literacy in the
1991 definitions was to enable the person to function in society and obtain
their full potential. That concept did not get into the health literacy
definition (except for the early AMA "read, understand and act on health care
information"..) but it is crucial.</FONT></SPAN></DIV>
<DIV dir=ltr align=left><SPAN class=797575117-04122008><FONT face=Arial
color=#0000ff></FONT></SPAN> </DIV>
<DIV dir=ltr align=left><SPAN class=797575117-04122008><FONT face=Arial
color=#0000ff>Joanne</FONT></SPAN></DIV>
<DIV> </DIV>
<DIV align=left><FONT face=Arial>Joanne G. Schwartzberg, MD<BR>Director, Aging
and Community Health<BR>American Medical Association<BR>515 N. State
St.<BR>Chicago, IL 60610<BR>312-464-5355<BR>fax:
312-464-5841<BR>Joanne.Schwartzberg@ama-assn.org</FONT></DIV>
<DIV> </DIV><BR>
<DIV class=OutlookMessageHeader lang=en-us dir=ltr align=left>
<HR tabIndex=-1>
<FONT face=Tahoma><B>From:</B> healthliteracy-bounces@nifl.gov
[mailto:healthliteracy-bounces@nifl.gov] <B>On Behalf Of </B>William
Smith<BR><B>Sent:</B> Thursday, December 04, 2008 6:06 AM<BR><B>To:</B>
healthliteracy@nifl.gov<BR><B>Subject:</B> [HealthLiteracy 2551] Re:
WednesdayQuestion: Lookingfor CompellingHealth Literacy
Facts<BR></FONT><BR></DIV>
<DIV></DIV>
<DIV>Having been on the IOM committee with Rima I want to emphasis the
importance of this finding from the report. Health literacy is not a
function of an individual in our minds - but of individuals, organizations,
and communities. I wish many times now that we had found a way to put that
in the definition and not in an explanatory note. </DIV>
<DIV> </DIV>
<DIV>The definition as it stands, as all of you know is: </DIV>
<DIV> </DIV>
<DIV><EM>Health literacy is the degree to which individuals have the capacity to
obtain,process, and understand health information and services needed to make
appropriate health decisions.</EM></DIV>
<DIV> </DIV>
<DIV>It is just as important to ask- <EM>Do I work in a health
literate organization? Is my community health literate?
Is my program health literate? </EM> Rima and I, at least the two of us
perhaps others, have been working on measurement tools to measure an
organization/community's health literacy. Despite the rhetoric we continue to
rely on measurements that focus only on the
individual. </DIV>
<DIV> </DIV>
<DIV>In the definition we used the word "individuals" and everyone
interprets that to be patients. Again we failed to clarify that a
physician is an individual. Nurses, pharmacists, family
members, pharmaceutical executives are also "individuals"
who require "the capacity to obtain, process, and understand basic health
information....." A physician who does not have the capacity to illicit
useful information from a patient, to understand what impact information he
gives a patient will have on that patient's compliance, is not health
literate. This is equally true for those us working in prevention - we too
are individuals who require the capacity to obtain, process and understand
health information about our audiences if we are ever to have a health literate
America. </DIV>
<DIV> </DIV>
<DIV>There is a second aspect of the definition which is often overlooked.
It is the word "services". Too much of our energy is going into making
written materials clear and in training disadvantaged groups to understand
the stupid things we tell them. The <EM>services</EM> word places
emphasis not on what we say, but on what we do to help people make appropriate
health decisions. I would love to see a marketing study of the service
aspect of health literacy as well as the information aspect.</DIV>
<DIV> </DIV>
<DIV>We should have done a better job of making this clear in the definition
itself. For me today, after speaking to dozens of groups, health literacy
is the: </DIV>
<DIV> </DIV>
<DIV><EM>"capacity of individuals, <STRONG>organizations and
communities</STRONG> to obtain, process, understand and <STRONG>share
</STRONG>basic health information and services needed to make appropriate health
decisions. "</EM></DIV>
<DIV><EM></EM> </DIV>
<DIV>Discussion of photonovels is interesting, but the real pay-off is the
re-structuring of our health care system so people can protect themselves from
disease and it consequences. </DIV>
<DIV> </DIV>
<DIV> </DIV>
<DIV>Wm. Smith<BR>Executive Vice President<BR>Academy for Educational
Development<BR>1825 Connecticut Ave., NW<BR>Washington, D.C.
20009<BR><BR>Organize policy until self-interest<BR>does what justice
requires.<BR>Phone: 202-884-8750<BR>Fax: 202-884-8752<BR>e-mail:
bsmith@aed.org<BR><BR>>>> "Rima Rudd" <RRUDD@hsph.harvard.edu>
12/3/2008 3:59 PM >>><BR>Hello... <BR>I will certainly think of my
'favorite' fact but I cannot resist commenting on the one just posted.<BR><BR>It
is not correct to state that people cannot do any of the tasks noted. A more
appropriate way to say this is "people below level X have difficulty completing
this task with accuracy and consistency" .<BR><BR>What is missing from this
insight [and it is valuable measure and an important insight] is the critical
finding from over 800 published studies that health materials are generally
poorly written and designed.<BR><BR>so... this does lead to my favorite
assertion taken from the IOM report:<BR><BR>Health literacy is a shared function
of social and individual factors. page 4<BR>or<BR>Health literacy is a shared
function of cultural, social, and individual factors. Both the causes and the
remedies for limited health literacy rest with our cultural and social
framework, the health and education system that serve it, and the interactions
between these factors. page 32<BR><BR><BR>in addition: <BR>The cost research is
not firmly established nor uniformly accepted. It is not possible, for example,
to differentiate between costs due to medical errors [errors made by
professionals] and costs due to literacy related errors [errors made by
patients]. I am very disquieted by the assumption that costs are due to patient
error or to patient deficits. <BR><BR>Rima<BR><BR>Rima E. Rudd, ScD,
MSPH<BR>Department of Society, Human Development & Health<BR>Harvard School
of Public Health<BR>677 Huntington Avenue<BR>Boston MA 02115<BR>Phone: 617 432
1135<BR>fax: 617 432 3123<BR>web:
www.hsph.harvard.edu/healthliteracy<BR>www.hsph.harvard.edu/sisterstogether<BR>----------------------------------------------------<BR>National
Institute for Literacy<BR>Health and Literacy mailing
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